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General NPI Number Information
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NPI Number | 1518918978
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Entity Type | Individual
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Provider Name | CARIDAD BRAVO-FERNANDEZ MD
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Gender | Female
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 03/21/2012
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Provider Practice Location Address
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Address Line | 15262 N. 75TH AVENUE, SUITE 400 PAIN SOLUTION CENTER, LLC
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City | PEORIA
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State | AZ
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Zip | 85381-4762
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Country | US
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Telephone | 623-486-1510
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Fax |
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Provider Business Mailing Address
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Address Line | 9200 W WISCONSIN AVE HOSPITAL BASED @ FROEDTERT HOSP.
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City | MILWAUKEE
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State | WI
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Zip | 53226-3522
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 45254
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License Number State | WI
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